Exercise Training in Older Patients with Heart Failure and Preserved Ejection Fraction: A Randomized, Controlled, Single-Blind Trial
HF with preserved left ventricular ejectionfraction (HFPEF) is the most common form of HF in the olderpopulation. Exercise intolerance is the primary chronic symptomin HFPEF patients and is a strong determinant of their reducedquality of life (QOL). Exercise training (ET) improves exerciseintolerance and QOL in HF patients with reduced ejection fraction.However, the effect of ET in HFPEF has not been examined ina randomized, controlled trial.
This was a randomized, attention-controlled,single blind study of 16 weeks of medically supervised ET (3days per week) on exercise intolerance and QOL in 53 elderly(mean age 70±6 yrs; range 60-82; 46 women, 7 men) patientswith isolated HFPEF (EF 
50%, and no significant coronary, valvular,or pulmonary disease). Attention controls received biweeklyfollow-up telephone calls. Forty-six patients completed thestudy (24 ET, 22 controls). Attendance at exercise sessionsin the ET group was excellent (88%; range 64 – 100%). There wereno trial-related adverse events. Peak exercise oxygen uptake,the primary outcome, increased significantly in the ET groupcompared to the control group (13.8±2.5 to 16.1±2.6ml/kg/min, change 2.3±2.2 ml/kg/min vs. 12.8±2.6to 12.5±3.4, change -0.3±2.1 ml/kg/min) (p=0.0002).There were significant improvements in peak power output, exercisetime, 6 minute walk distance, and ventilatory anaerobic threshold(all p<0.002). There was improvement in the physical QOLscore (p=0.03) but not the total score (p=0.11).
50%, and no significant coronary, valvular,or pulmonary disease). Attention controls received biweeklyfollow-up telephone calls. Forty-six patients completed thestudy (24 ET, 22 controls). Attendance at exercise sessionsin the ET group was excellent (88%; range 64 – 100%). There wereno trial-related adverse events. Peak exercise oxygen uptake,the primary outcome, increased significantly in the ET groupcompared to the control group (13.8±2.5 to 16.1±2.6ml/kg/min, change 2.3±2.2 ml/kg/min vs. 12.8±2.6to 12.5±3.4, change -0.3±2.1 ml/kg/min) (p=0.0002).There were significant improvements in peak power output, exercisetime, 6 minute walk distance, and ventilatory anaerobic threshold(all p<0.002). There was improvement in the physical QOLscore (p=0.03) but not the total score (p=0.11).The authors of this important trial concluded that ET improves peak and submaximal exercise capacityin older patients with HFPEF.
REFERENCE:
Dalane W. Kitzman1; Peter Brubaker; Timothy M. Morgan; Kathryn P. Stewart and William C. Little. Exercise Training in Older Patients with Heart Failure and Preserved Ejection Fraction: A Randomized, Controlled, Single-Blind Trial. Circ Heart Fail published September 17, 2010.
